Inside the New Patient-Driven Star Ratings for Home Health

The Centers for Medicare & Medicaid Services shed more light Thursday on a new star rating system for home health agencies, based on what consumers say about Medicare-certified providers’ performance.

The “Patient Survey Star Ratings,” to go into effect in January 2016, will be based on data from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey.

The HHCAHPS Survey is a national, standardized, 34-item survey of patients’ experience of care received from their home health agency. The surveys are conducted by independent survey vendors and can be completed via mail, phone or through a mix of both.


The Patient Survey Star Ratings are not to be confused with the “Quality of Patient Care Star Rating” (based on OASIS assessments and claims data). The OASIS-based ratings also are new, with providers having received previews of their first-ever rating last month. Agencies’ star ratings are set to be posted for the public in July.

In giving feedback on this first type of star rating system, providers told CMS that patient satisfaction also should play a role; CMS developed the Patient Survey ratings in response to this feedback.

Four HHCAHPS measures will receive a star rating: care of patients; communication between providers and patients; specific care issues; and overall ratting of care provided by the home health agency. There will also be a Survey Summary Star Rating.


However, only certain home health agencies will be eligible for HHCAHPS star ratings — those that have at least 40 completed surveys over the four-quarter reporting period. Home health agencies that do not have sufficient completed surveys will still have their HHCAHPS measures publicly reported on Home Health Compare, but without stars attributed to them.

The first publicly reported star ratings, to be released in January of next year, will reflect data from patients served from July 2014 through June 2015.

The Math Behind the Star

Individual survey responses are converted into linear scores on a 0- to 100-point scale, explained a CMS spokesperson during an Open Door Forum call with providers and other stakeholders.

“We don’t just look at the positive responses,” she said. “We use all levels of responses.”

More positive responses will receive a higher value, she said.

After the linear scores are created, CMS will create a “patient mix,” which adjusts for patient characteristics that affect response tendencies.

“All agencies may not see similar populations, and this could affect their ratings,” she said. “That’s the idea behind the patient mix.”

For example, one of the patient mix factors is whether that client lives alone. “Patients who live alone tend to give lower scores, which is clearly outside of agencies’ control,” she said. “So, this is something we statistically adjust for.”

Other patient mix adjusters include age, education, and language in which survey was completed, among others.

After patient mix adjusters are applied, linearized scores are then converted into HHCAHPS star ratings in a process that involves a statistical clustering technique, which is meant to “maximize differences between groups and minimize differences within groups,” CMS said.

Sample Star Ratings Report 

CMS will issue a sample Star Rating Preview Report in October 2015, the agency announced.

The preview report will include data from patients served from April 2014 through March 2015. The star ratings will not be publicly reported.

“This preview report will provide agencies the opportunity to see how they compare on star ratings,” CMS said.

For more information about the Patient Survey Star Ratings, click here.

Written by Cassandra Dowell